Guide Reconsidering Law and Policy Debates: A Public Health Perspective

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In many instances actions by the state to maintain public health and security have been forced upon individuals and groups. To consider public health ethics seriously, one must contemplate the intersection between public health and law. The law is interwoven into each segment of public health, 10 defining the boundaries of what public health authorities can and cannot do, setting limits to their power, and placing restrictions on their relationships with individuals or social groups.

With differing degrees of success, the state attempts to use the law to construct and impart lifestyle norms and healthy, safe behavior. To a great extent, institutions of law constitute a central arena for discourse on public health measures. A wealth of literature exists on health law, but it is mainly concerned with medicine and personal health care services governing clinical decision making, delivery, organization, and finance. Public health law should have a different focus from the aforementioned laws.

Traditionally, public health law was largely aimed at dealing with communicable diseases and other negative externalities with large-scale health impacts such as pollution. Understanding cultural and social determinants of health can inform public health practitioners when applying health promotion programs. Public participation and building trust between the establishment — medical and non-medical — are crucial and must be considered when designing public health interventions. There is a need for a multi-disciplinary cooperation, bringing epidemiology, public health, and policy-making closer to the humanities and social sciences.

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In this way, the growing global health challenges associated with migration, ethnic conflicts, war, and environmental degradation can be better understood within their context. Public health ethics can foster forums for public health professionals and engage them in meaningful civic participation. Such a framework will require political impetus for reform. Recently, the Israeli Association of Public Health Physicians has convened a working group of professionals to discuss the possibility of creating a public health code of ethics.

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In this process we follow similar efforts conducted internationally, such as by the American Public Health Association. A well-discussed regional perspective is necessary in understanding the public health needs of the Middle East so that if and when the time comes, dealing with imminent public health threats such as pandemic influenza or environmental health challenges will not come as a surprise.

It behooves the welfare of a community to understand the social and ethical nuances of a particular region before enacting effective and relevant public health reforms. His current research deals with public health policy, global health, health and immigration, health disparities, vaccination policy, and environmental health policy, focusing on contested science debates. Davidovitch serves on the Hektoen International editorial board. While its initial interests centered on infectious diseases, sanitation, and hygiene, its current health scope has grown to include issues such as health promotion, the rise of chronic diseases, and health inequalities.

Emerging and re-emerging infectious diseases constantly remind us that the fight over contagious diseases is far from over. Recent social, cultural, and technological changes have reshaped the discipline of public health. While both bioethics and health law help healthcare professionals identify and respond to legal and moral dilemmas in their work, there has been a growing interest in separating public health law from ethics in the last decade.

Introducing these new perspectives can help encourage social and ethical sensitivities to current public health challenges, ranging from reducing health inequities both within and between countries to implementing the new International Health Regulations IHR in the context of emerging infectious diseases and pandemic influenza. Notes Nancy E. Securing good health for the whole population.

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Justice, for example, can offer guidance on how to allocate scarce therapeutic resources in a public health crisis, such as pandemic influenza. Social justice, however, demands more than merely a fair distribution of resources.

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While health hazards threaten the entire population, the poor and disabled are at heightened risk. For example, in response to devastating hurricanes on the Gulf Coast in and the East Coast in and , city, state, and federal agencies failed to act expeditiously and with equal concern for all citizens, particularly the poor and disabled. Neglect of the needs of the vulnerable predictably harms the whole community by eroding public trust and undermining social cohesion. Social justice thus encompasses not only a core commitment to a fair distribution of resources, but it also calls for policies of action that are consistent with the preservation of human dignity and the showing of equal respect for the interests of all members of the community.

It thus has an obligation both toward government, which controls it, and toward the public that it serves.

Guiding Principles for Reform

Law defines the jurisdiction of public health officials and specifies the manner in which they may exercise their authority. State public health statutes create public health agencies, designate their mission and core functions, appropriate their funds, grant their power, and limit their actions to protect certain liberties. Of the 10 greatest public health achievements of the twentieth century, all were realized, at least in part, through legal reform or litigation: vaccinations, safer workplaces, safer and healthier foods, motor vehicle safety, control of infectious diseases, the decline in deaths from coronary heart disease and stroke, family planning, tobacco control, healthier mothers and babies, and fluoridation of drinking water.

Public health law experts are playing a vital role in addressing the leading public health challenges of the twenty-first century. Public health law consists of the basic statutes that empower public health agencies and a number of legal tools, including:. The United States faces many formidable challenges in safeguarding the population from infectious and noncommunicable diseases and injuries. The mounting toll of Type 2 diabetes, dramatically rising rates of opioid overdose, outbreaks of measles and pertussis, and Zika virus transmission brings ethical values into tension.


The duty to protect the public—a collective good—must be weighed against individual rights to liberty, privacy, bodily integrity, freedom of association, and the free exercise of religion. In view of these competing values, public health practitioners are grappling with several critical questions:. When facing the public health challenges of coming decades, policy makers will be unable to avoid ethical dilemmas. Failure to move aggressively—even with incomplete scientific information—can have disastrous consequences, while actions that prove to have been unnecessary will be viewed as draconian and wasteful.

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Transparency is crucial. Policymakers must be willing not only to clearly explain the reasons for restrictive measures, but also to openly acknowledge when new evidence warrants a reconsideration of policies. Potential interventions must be evaluated according to carefully honed ethical criteria. In the future as in the past, public health decisions will profoundly reflect the manner in which societies both implicitly and explicitly balance values that are intimately related and inherently in tension.

Lawrence O. Lindsay F. How Is My Site? Wiley Highlights. Public health encompasses what society does to assure the conditions that are necessary for its members to be healthy, including economic, social, and environmental factors.

The public health tradition adopts a prevention orientation and views health from the population, rather than individual, perspective. Public health regulation involves potential trade-offs as well as synergies between collective goods and individual interests. In addition to the principle of individual autonomy, public health decision-makers are guided by a commitment to social justice.

Reconsidering Law and Policy Debates: A Public Health Perspective

State public health statutes create public health agencies, designate their mission and core functions, appropriate their funds, grant their power, and limit their actions in order to protect individual liberties. Legal tools for advancing public health include taxation, spending, and resource allocation; information and education; zoning and city planning; regulation of persons and businesses; tort litigation; and deregulation to remove legal barriers to good public health practice.

Formidable public health challenges, such as infectious disease epidemics; declining vaccination rates; the alarming increase in opioid overdoses; and noncommunicable diseases associated with tobacco use, unhealthy eating, and physical inactivity, highlight the urgent need for public health interventions that balance ethical values in a transparent and deliberative manner. Support our work. John G. Culhane, ed.

Rethinking public health law and ethics – a regional perspective – Hektoen International

Wendy E. David P. Fidler and Lawrence O. Ronald Bayer, Lawrence O. Gostin, Bruce Jennings, and Bonnie Steinbock, eds. James F. Childress, Ruth R. Faden, Ruth D. Gaare, et al.